Individual
DEEPA DUTTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3455 WILKENS AVE STE 208, BALTIMORE, MD 21229-5265
(410) 644-4320
Mailing address
3455 WILKENS AVE STE 208, BALTIMORE, MD 21229-5265
(410) 644-4320
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
D0019514
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
61489901
BLUE SHIELD
MD
01
—
W2270017
GHI
DC
Enumeration date
09/12/2006
Last updated
07/08/2007
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